| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,017 |
782 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,117 |
837 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
809 |
580 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,220 |
787 |
$10K |
| D0274 |
Bitewings - four radiographic images |
308 |
247 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
326 |
265 |
$6K |
| D1110 |
Prophylaxis - adult |
136 |
109 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
293 |
193 |
$2K |
| D1206 |
Topical application of fluoride varnish |
170 |
142 |
$2K |
| D0270 |
|
511 |
345 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
61 |
58 |
$1K |
| D0330 |
Panoramic radiographic image |
248 |
203 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
13 |
$495.88 |
| D4341 |
|
92 |
26 |
$0.00 |